1. Field of the Invention
The present invention relates to a method of anastomosis of blood vessels, more particularly to a method of an end-to-side anastomosis of an end portion of one blood vessel to a side portion of another blood vessel and instruments used for this anastomosis method. Also, the present invention relates to a method of connection of a medical device constituting an extracorporeal circulation circuit, such as a pump-oxygenator, a dialyser for blood or body fluid, at a side portion of a blood vessel.
2. Description of the Related Art
In operations, an end-to-side anastomosis by connection of an end portion of a blood vessel with a side portion of another blood vessel to communicate the blood vessels with each other is sometimes carried out. For example, in coronary artery bypass graft (CABG) for the therapy of angina pectoris, cardiac infarction, arrythmia and so forth caused by insufficient circulation to the cardiac muscle due to the constriction of coronary artery, an end portion of internal thoracic artery or great saphenous vein, for example, is anastomosed (connected) to a side portion of coronary artery on its peripheral side with respect to the constricted site.
The end-to-side blood vessel anastomosis method is carried out usually by partially dissecting a side portion of one blood vessel to form an opening having a peripheral portion and suturing the peripheral portion with an end portion of another blood vessel with a needle and a suture. Such a technique requires a considerably high level skill. In particular, anastomosis of coronary artery bypass graft, which is carried out on blood vessels that are very thin and under a narrow field of vision, is very difficult to carry out.
In end-to-side anastomosis method for blood vessels, it is particularly important to maintain the opening formed on the side portion of one blood vessel to have a sufficient size for it to be anastomosed with the end portion of another blood vessel when the blood vessels are sutured with each other. In this respect, a conventional method as disclosed in U.S. Pat. No. 2,453,056 has been carried out as follows. That is, the peripheral portion of the opening attached to the side portion of a blood vessel is clipped with a plurality of tweezers to retain the opening at the side portion of the blood vessel in an expanded state sufficient for the end portion of another blood vessel to be anastomosed thereto and then the peripheral portion of the opening at the side portion of one blood vessel and the end portion of another blood vessel are connected to each other. However, the blood vessel of which anastomosis is needed usually is hardened and very brittle because of calcification or the like so that there is the fear that the blood vessel when clipped with tweezers or the like could be torn at the dissected portion.
Also, coronary artery bypass graft has been conventionally carried out in a cardiac arrest state using a pump-oxygenator. However, use of a pump-oxygenator gives much stress on patients. Accordingly, in recent years, low stress coronary artery bypass graft carried out in a state where the heart beats (under heart beating) (hereinafter referred to as xe2x80x9cbypass graft under heart beatingxe2x80x9d) has been carried out in order to alleviate load to the body of a patient, shorten the time required for curing and reduce medical expenses to be paid by the patient.
In the bypass graft under heart beating, the surface of the heart moves due to the heartbeat, which makes the blood vessel anastomosis more difficult.
In this regard, a method of connection between a peripheral portion of an opening at the side portion of one blood vessel and an end portion of another blood vessel by using a special instrument is disclosed in U.S. Pat. No. 4,787,386, for example. The special instrument has an annular shape provided with an opening in the center with a plurality of protrusions provided on an outer periphery of the annular portion. The protrusion of the instrument are pierced into the peripheral portion of the opening attached to the side portion of one blood vessel to retain the opening at the side portion of the blood vessel in an expanded state having a desired size. Then, the peripheral portion of the opening at the side portion of the blood vessel is connected to the end portion of another blood vessel.
However, in this connection method, it is necessary to retain the opening of a blood vessel in an expanded state with the tweezers or the like so as to have a sufficient size for the attachment of the instrument when the protrusions of the instrument thereto are pierced into the peripheral portion of the opening. This procedure itself is difficult as described above. Also, after the anastomosis, the protrusions of the instrument exist exposed in the passage of blood in the blood vessel. When they are in contact with the blood flow, they are recognized as foreign matter, leading to the possibility of thrombus formation.
An object of the present invention is to provide a method of end-to-side anastomosis of blood vessel that facilitates expansion of an opening provided on a side portion of a blood vessel to a desired size and enables retention of the opening in that state when a blood vessel is subjected to end-to-side anastomosis, and in which no foreign matter is present in the passage of blood in the blood vessel after completion of anastomosis.
Another object of the present invention is to provide an instrument for use in the method of end-to-side blood vessel anastomosis and more particularly to provide a blood vessel connecting instrument, a blood vessel supporting instrument or a surgical instrument.
Still another object of the present invention is to provide a method of connection of a medical device constituting an extracorporeal circulation circuit, such as a pump-oxygenator, a dialyser for blood or body fluid, with a side portion of a blood vessel.
The above objects have been achieved by the following items (1) to (34) according to the present invention.
(1) A method of end-to-side anastomosis of blood vessels for connecting a side portion of a first blood vessel to an end portion of a second blood vessel, comprising the steps of:
holding a first site on the side portion of the first blood vessel located in the vicinity of a peripheral portion of an opening formed on the side portion of the first blood vessel using a holder, and partially elevating the side portion of the first blood vessel;
superimposing a second site on the side portion of the first blood vessel that is more distant from the peripheral portion of the opening formed on the side portion of the first blood vessel than that from the first site and the end portion of the second blood vessel on each other and fixing them with a ring-shaped fixing member to each other; and
detaching the holder from the first blood vessel when they are fixed using the fixing member or after they are fixed.
(2) A blood vessel connecting instrument for connecting to an opening formed on a side portion of a first blood vessel an end portion of a second blood vessel, comprising:
at least one engaging member having an engaging portion for enabling engagement in the vicinity of a peripheral portion of an opening formed on the first blood vessel from inside thereof; and
a holding means for holding the state of engagement of the engaging portion in the vicinity of the peripheral portion of the opening in the first blood vessel.
(3) A blood vessel connecting instrument according to the item (2) above, wherein the holding means is a holding member having a clipping portion that can clip a part of the first blood vessel in the vicinity of the opening in the first blood vessel between it and the engaging portion.
(4) A blood vessel connecting instrument according to the item (2) or (3) above, wherein the engaging member is arranged in the holding member movable in a longitudinal direction thereof.
(5) A blood vessel connecting instrument according to any one of the items (2) to (4) above, comprising a plurality of engaging members, at least two of which are variable with respect to the distance thereof.
(6) A blood vessel connecting instrument according to any one of the items (2) to (5) above, wherein the engaging member comprises a linear body and the engaging portion comprises a bent end portion of the linear body.
(7) A blood vessel connecting instrument according to any one of the items (2) to (6) above, further comprising a fastener member for superimposing a portion in the vicinity of the peripheral portion of the opening in the first blood vessel on the end portion of the second blood vessel and fastening them to fix them.
(8) A blood vessel connecting instrument according to the item (7) above, wherein the fastening member is ring-shaped and the diameter thereof is variable.
(9) A blood vessel connecting instrument according to the item (7) or (8) above, further comprising a guide portion for guiding the fastening member to a fixing position of the first blood vessel and the second blood vessel, and a moving means for moving the fastening member to the fixing position.
(10) A blood vessel connecting instrument according to the item (9) above, wherein the fixing portion is at a position remoter from the opening than the position at which the engaging portion is engaged with the inner surface of the first blood vessel.
(11) A blood vessel connecting instrument according to any one of the items (7) to (10) above, wherein the fastening member has a receiving member for receiving fastening force of the fastening member.
(12) A blood vessel connecting instrument according to the item (11) above, wherein the receiving member is ring-shaped.
(13) A blood vessel connecting instrument according to the item (11) or (12) above, wherein the receiving member has a groove on its outer periphery.
(14) A blood vessel connecting instrument according to any one of the items (11) to (13) above, further comprising a blood vessel supporting member for supporting the second blood vessel together with the receiving member.
(15) A blood vessel connecting instrument according to the item (14) above, wherein the blood vessel supporting member has a pair of arm portions that can come closer to and be spaced from each other.
(16) A blood vessel supporting instrument comprising:
a pair of arm portions;
a pair of needle portions attached to an end portion of the both arm portions, respectively and arranged substantially parallel to each other;
wherein the needle portions are pierced into the blood vessel to support and manipulate a portion of the blood vessel.
(17) A blood vessel supporting instrument according to the item (16) above, wherein the needle portions has substantially circular or substantially ellipsoidal shape in a cross sectional view.
(18) A blood vessel supporting instrument according to the item (16) or (17) above, wherein the needle portions have each a length of 1.5 to 40.0 mm.
(19) A blood vessel according to any one of the items (16) to (18) above, wherein a distance between the both needle portions is variable.
(20) A blood vessel supporting instrument according to any one of the items (16) to (19) above, wherein the both needle portions are connected to each other in at least one position of a midway in the longitudinal direction thereof or the other end portion thereof.
(21) A blood vessel supporting instrument according to any one of the items (16) to (20) above, wherein the supporting instrument is capable of being fixed to a stabilizer for suppressing movement of heart surface.
(22) A blood vessel supporting instrument according to any one of the items (16) to (21) above, further comprising a dissection instrument attachment portion for detachably attaching a dissection instrument for dissecting the blood vessel.
(23) A blood vessel supporting instrument according to the item (22) above, wherein the dissection instrument is capable of being attached so that relative positional relation between a distal end portion of the dissecting instrument and the needle portions can be controlled.
(24) A surgical instrument comprising:
a blood vessel supporting instrument according to any one of the items (16) to (23) above;
a dissecting instrument attachable to the blood vessel supporting instrument;
wherein a distal end portion of the dissecting instrument is movable with respect to the needle portions.
(25) A surgical instrument according to the item (24) above, wherein the instrument is capable of performing dissection in an appropriate length while controlling distance of movement of the distal end portion of the dissecting instrument with respect to the needle portions.
(26) A surgical instrument according to the item (24) or (25) above, wherein the distal end portion of the dissecting instrument is displaceable between a first position of being retracted from the blood vessel and a second position of dissecting the blood vessel.
(27) A surgical instrument according to any one of the items (24) to (26) above, further comprising a manipulating portion for manipulating movement of the distal end portion of the dissecting instrument to the needle portions.
(28) A surgical instrument according to any one of the items (24) to (27) above, wherein the dissecting instrument is one selected from the group consisting of a knife, a laser probe, an electric knife, and an ultrasonic knife.
(29) A method of end-to-side anastomosis of blood vessels according to the item (1), wherein the blood vessel connecting instrument according to the item (2) is utilized.
(30) A method of end-to-side anastomosis is of blood vessels according to the item (1), wherein the blood vessel supporting instrument according to the item (16) is utilized.
(31) A method of connection of a medical device constituting an extracorporeal blood circulation with a side portion of blood vessel, comprising the steps of:
holding a first site on the side portion of the blood vessel located in the vicinity of a peripheral portion of an opening formed on the side portion of the blood vessel using a holder, and partially elevating the side portion of the first blood vessel;
superimposing a second site on the side portion of the first blood vessel that locates more distant from the peripheral portion of the opening formed on the side portion of the first blood vessel than that of the first site therefrom is and a terminal end portion of a passage for blood of the medical device having a passage for blood wherein can connect with a blood vessel on each other and fixing them with a ring-shaped fixing member to each other; and
detaching the holder from the blood vessel when they are fixed using the fixing member or after they are fixed.
(32) A method of connection of a medical device according to the item (31), wherein the blood vessel connecting instrument according to the blood vessel connecting instrument according to the item (2) is utilized.
(33) A method of connection of a medical device according to the item (31), wherein the blood vessel supporting instrument according to the item (16) is utilized.